Specialty pharmacy is losing some of its sizzle.

Below you’ll find our list of ten deals from last year, along with trends since 2014. Our analyses show that merger and acquisition activity is down sharply from its 2016 peak.

Some highlights:

• Pharmacy benefit managers (PBMs) were busy again. CVS Health bought two more specialty pharmacies. OptumRx bought one-time industry leader Diplomat Pharmacy.

• Private equity firms continued to invest in specialty pharmacy, but deals seem to be smaller and more focused.

Go-go growth and a vibrant M&A market look like distant memories. Fewer new specialty pharmacies are starting up, the two biggest companies have been acquired, and market share continues to concentrate with the PBM-owned specialty pharmacies. This is your wake up call.

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Informa Connect-CBI’s Formulary and Access 2020

April 1-3, 2020 | San Francisco, CA

www.cbinet.com/formulary

As patient affordability barriers increase, the pharma/biotech industry must evolve to meet these challenges and ensure patient access to critical, life-saving therapies. Challenges continue to arise for manufacturers, including accumulator programs, state-level copay legislation, formulary exclusions, high deductible plans and changes in benefit design.

At the 6th Annual Formulary and Access Summit a dynamic group of experts will drive the dialogue to prepare you for ongoing changes impacting patient access and formulary placement. Some of the speakers will include representatives from Allergan, Portola Pharmaceuticals, Prime Therapeutics, Sunovion Pharmaceuticals, CVS Health and more.

The 2020 agenda features a wide variety of topics, with highlights including:

• Copay Accumulator Topic Intensive where you’ll unravel program complexities and navigate the impact of this cost-shifting benefit design.
• Workshops on Keeping Up with Copay Industry Trends and Access and Reimbursement Executive Exchange.
• Tailored Tracks on Access and Affordability, Rebates and Contracting, and Strategic Launch Planning.
• Partnership Pavilion where you’ll navigate the future of pharma, PBM and payer relationships.
• Employer Perspective Fireside Chat where you’ll assess reimbursement strategies, contract and pricing and the state of health plan design, and explore the impact of distribution, retail and wholesale for brand and generic on PAPs.
• Patient Spotlight where you’ll take an inside look at the patient experience and real-world access challenges.

PLUS! Just added to the agenda is a case study from Matt Cook, VP of Payer Access and Commercial Strategy at Omada Health, which was selected for Express Scripts Industry-First Digital Health Formulary.

Download the complete agenda and speaker list to get the full picture of what to expect in April.

Visit www.cbinet.com/formulary for further details and to register. Drug Channels readers will save $300 off the standard rate when they use code MZN973 and register prior to March 13th.*

Informa Connect-CBI will see you there!

*Cannot be combined with other offers or used towards a current registration. Cannot be combined with special category rates, clinic/hospital rates, non-profit rates other offers. Other restrictions may apply.

The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees.

        

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Pharmacy-related price concessions in Medicare Part D—known as pharmacy DIR fees–have grown faster than most people realize.

We estimate that these payments reached $9.1 billion in 2019. This figure indicates that about 18% of total Medicare Part D rebates are now paid by pharmacies, not manufacturers. Details below.

To address concerns about how these fees are computed, the Centers for Medicare & Medicaid Services (CMS) has proposed some minimal transparency requirements for monitoring the metrics behind DIR fees. I suspect that the proposal will have no near-term impact on slowing the growth trends.

Our long time readers know that I’ve been skeptical about pharmacy owners’ claims regarding the impact of DIR fees. But it does now appear that these payments have become a significant economic burden. When the facts change, I change my mind. What do you do?

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On March 10, 2020, Drug Channels Institute will release The 2020 Economic Report on U.S. Pharmacies and Pharmacy Benefit Managers. This report—our eleventh edition—remains the most comprehensive, fact-based tool for understanding the entire U.S. drug pricing, reimbursement, and dispensing system.

We are providing you with the opportunity to preorder this thoroughly updated and revised 2020 edition at special discounted prices. This means that you can be among the first to access our new report. Those who preorder will receive a download link before March 10.

You can pay online with all major credit cards (Visa, MasterCard, American Express, and Discover) or via PayPal. Click here to email us if you would like to pay by corporate purchase order or check.

Special preorder and launch pricing discounts will be valid through March 22, 2020.

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Informa Connect – CBI’s 6th Edition Drug Pricing Transparency Congress

March 30-31, 2020 | Philadelphia, PA

www.cbinet.com/drugpricing

Are you and your team on the pulse? Hundreds of leaders in Drug Pricing have benefited from Informa Connect – CBI’s 6th Edition Drug Pricing Transparency Congress conference series. Join key stakeholders at this timely meeting as they address the current and future drug pricing transparency regulations, assess how companies are planning internally for these changes and gain a preview of what’s to come in 2020 and beyond.

As regulations and legislation continue to evolve, it is imperative for companies to stay ahead of these anticipated changes for strategic long-term planning. We encourage you to prepare for 2020 now. Drug Channels readers will save $400 off the standard rate when they use code DPT400 and register prior to February 28th*. Sign up to see the agenda here.

Experts from Boehringer Ingelheim, Sidley Austin LLP, Covington & Burling LLP, Porzio Life Sciences, LLC, Ingenus Pharmaceuticals, Chiesi USA, Inc., Sandoz, Amneal Pharmaceuticals, Novo Nordisk, ClassOne Insights, BIO, PhRMA, and more will lead robust discussions on topics such as:

• Review State Transparency Requirements
• Examine how the future of pricing transparency requirements will impact commercialization, reimbursement and drug pricing models
• Keep a Pulse on New Legislation and Current Industry Efforts
• Assess evolving drug pricing transparency legislation and litigation
• Comprehend legal interpretations of drug pricing transparency and reporting laws currently on the books and the policy outlook for 2020 and beyond
• Explore federal initiatives for pricing transparency
• Benchmark with industry peers on managing transparency requirements and reporting for compliance
• Safeguard your most sensitive information — Intersection of transparency legislation and trade secret law

New for 2020!

• Enhanced State Transparency Reporting Requirements Showcase
• Ask the Experts Round Up
• 2-day programming and extended networking opportunities

Visit www.cbinet.com/drugpricing for further details and to register. Drug Channels readers will save $400 off the standard rate when they use code DPT400 and register prior to February 28th*.

Informa Connect – CBI will see you there!

*Offer applies to standard rates only and may not be combined with other offers, category rates, promotions or applied to an existing registration. Offer not valid on workshop only or academic/non-profit registrations. Other restrictions may apply.

The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees.

        

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The Centers for Medicare & Medicaid Services (CMS) has just released its first 2020 data on enrollment in Medicare Part D prescription drug plans (PDPs).

Our exclusive analysis of these numbers finds that for 2020, 92% of seniors are enrolled in PDPs with preferred pharmacy networks. That’s an increase from last year’s figure (88%).

Below, we use the new enrollment data to examine the major pharmacy chains’ position within the 25 major Part D plans that have preferred networks.

As you will see, in 2020 Walmart seems poised to capture market share from Walgreens, while CVS has maintained its position. Rite Aid’s position looks better than it has in previous years.

A pharmacy’s per-prescription profits are lower in preferred plans. However, I expect that pharmacies will continue to accept low reimbursements and suffer with direct and indirect remuneration (DIR)  payments in exchange for increasing or maintaining store traffic.

I'll have an update on pharmacy DIR soon. In the meantime, the pharmacy industry shoudl consider what John Maynard Keynes once observed: Markets can remain irrational longer than you can remain solvent.

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The World Congress 8th Annual Patient Congress

The 2020 World Congress Patient Congress takes place April 6 -7 at the Doubletree Hotel in Center City, Philadelphia. Now in its 8th year this is an outstanding educational and networking event that explores innovative and collaborative ways to improve access and health outcomes for patients.

Drug Channels readers save $100 off the standard rate when you use promo code DCAD and register by March 31, 2020.* To register your team, contact World Congress at 800-767-9499; or email WCReg@worldcongress.com.

The agenda features C-level keynote discussions and thought leader presentations across three streams of content:

• The Patient Adherence and Engagement Track brings together multi-stakeholders to collaborate to drive patient engagement and positively influence patient adherence

• The Patient Advocacy Track provides an opportunity for pharmaceutical manufacturers to join together with patient groups, patient leaders, and policy makers to examine ways to tackle the complexities of patient advocacy and the health care market

• The Copay Summit convenes manufacturers, payers, states, government officials, advocacy and foundational groups, to examine regulations on the use of Copay and Coupon programs, and Copay Accumulator and Maximizers

The distinguished speaking faculty includes executives from Leo Pharma, Enzyvant, and UnitedHealth Care. Here’s a sample of the thought-provoking sessions:

• Harvey Littman, Senior Vice President, Chief Financial Officer, Capital BCBS on the payer’s perspective on value-based payment systems
• Andrea Furia-Helms, Director, Patient Affairs, FDA, on how to drive patient engagement
• David Kalowsky, Director, Patient Access, Eyepoint Pharmaceuticals, on key strategies to designing effective copay programs

The Congress is honored to host the WEGOHealth Patient-Choice Awards, where patients will share their stories and organizations that truly put patients first will be recognized.

More than 150+ industry leaders representing life sciences companies, pharmacies, health plans, provider organizations, patient groups, and patient leaders will be in attendance. Join the conversation around innovative and collaborative ways we can improve access and health outcomes for patients. Develop your organization’s patient-centric strategy from drug development through commercialization, break down internal silos, and improve patients’ lives across the entire continuum of care.

Benefit from the opportunity to connect, learn, and share best practices in an elite networking forum resulting in an exchange of valuable patient-centric strategies.

Drug Channels readers save $100 off the standard rate when you use promo code DCAD and register by March 31, 2020.* To register your team, contact World Congress at 800-767-9499; or email WCReg@worldcongress.com.

*Cannot be combined with other offers or prior registrations.

The content of Sponsored Posts does not necessarily reflect the views of Pembroke Consulting, Inc., Drug Channels, or any of its employees.

        

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Super Bowl LIV is here. Time for some blow-out beer commercials, occasionally interrupted by the 49ers and Chiefs.

But who needs a Super Bowl-party when you can tackle this month’s selection of notable news stories, intercepted for you from the Drug Channels gridiron:

• Fumble: Express Scripts will stop buying generic drugs with Walgreens

• Trick play: Amazon signals global pharmacy ambitions

• Pass interference: The gross-to-net bubble for Humira

• Touchdown! ABC’s CEO pens a good letter to the editor

• Defensive line: Competition still lowers prices, say the FDA

Plus, the new Miss America is … a PharmD student?

P.S. Join the nearly 8,800 followers of my daily musings and links to neat stuff at @DrugChannels on Twitter. My recent tweets have highlighted best practices for biosimilar adoption, white bagging, hospital profits, 340B program oversight, insulin economics, the innovation ecosystem, California’s bonkers idea for generic drugs, Baby Yoda, and much more.

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Our high-list-price/high-rebate system remains a fundamental source of warped incentives and cascading problems within the Medicare Part D program.

For proof, check out the previously unpublished data below on market share for products that treat hepatitis C. Despite manufacturers offering products with lower list prices, Medicare Part D plans have rejected the therapeutically identical but lower-priced versions of these drugs.

List prices significantly affect seniors’ out of-pocket costs, so Part D plans are needlessly costing many of them thousands of dollars. The federal government's Medicare spending is also unnecessarily higher.

Anyone concerned about drug prices should pay close attention to this situation. Part D plans and seniors who don’t need specialty medications are benefiting, while seniors who need treatment with specialty medications are ripped off. Just another day inside the gross-to-net bubble!

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For 2020, the two largest pharmacy benefit managers (PBMs)—Express Scripts and the Caremark business of CVS Health—have again increased the number of drugs they have excluded from their standard formularies. The 2020 formulary exclusion lists are available below for your downloading pleasure.

Below, I highlight my key takeaways from the 2020 lists:

• The number of exclusions

• Management of specialty drugs

• Indication-based formularies

• The slow adoption of biosimilars

• The PBMs’ patient-unfriendly exclusions in the hepatitis C category

Formulary exclusions have emerged as a powerful tool for PBMs to gain additional negotiating leverage against manufacturers. The prospect of exclusion leads manufacturers to offer deeper rebates to avoid being cut from the formulary. Exclusions are therefore a key factor behind falling brand-name net drug prices.

Read on for a look at this year’s exclusions along with some closing thoughts on what exclusions mean for patients.

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